Tuesday, October 06, 2009

Much has been made of how the eeeevil insurance companies routinely deny much-needed care. Of course, carriers don't deny "care," they deny "claims" - an important (and oft-overlooked) distinction.

Carriers do, in fact, deny some claims. As we've seen, some of these are justified, and some are not. One of the benefits of consumer-centric health plans, by the way, is that they mitigate this problem by empowering (and enabling) one to pay one's own's claims, if desired and/or necessary. One question that we haven't seen addressed, though, is just how prevalent claims denials are, and which carriers are the worst offenders. Well, we can wonder no more:

That "report card" contains some very interesting information. For one thing, we learn that Coventry (headquartered in Bethesda, MD) seems to be the quickest at actually paying claims, and (among the insurers thus "graded"), the most accurate. Still, the critics' focus is on claim "rejection," that is, the percentage of folks whose claims are outright denied. And that's a valid (if perhaps narrowly defined) metric; after all, who wants to willingly buy coverage from a carrier which routinely denies claims?

So, which is the most egregious perpetrator?

The answer may surprise you:

[ed: from page 5 of the linked report]

Yes, you read that correctly: the insurer which routinely denies the most claims is none other than the largest national health scheme we currently have: Medicare (which denies almost two and a half times as many claims as best-ranked Coventry). This is all the more bewildering, since so many folks point to Medicare as a viable, even preferable model of financing health care delivery. This should come as no surprise, however, given the drastic cuts already in place (with more on the way), which will no doubt increase the terrible score.

Much has been made of how the eeeevil insurance companies routinely deny much-needed care. Of course, carriers don't deny "care," they deny "claims" - an important (and oft-overlooked) distinction.

Carriers do, in fact, deny some claims. As we've seen, some of these are justified, and some are not. One of the benefits of consumer-centric health plans, by the way, is that they mitigate this problem by empowering (and enabling) one to pay one's own's claims, if desired and/or necessary. One question that we haven't seen addressed, though, is just how prevalent claims denials are, and which carriers are the worst offenders. Well, we can wonder no more:

That "report card" contains some very interesting information. For one thing, we learn that Coventry (headquartered in Bethesda, MD) seems to be the quickest at actually paying claims, and (among the insurers thus "graded"), the most accurate. Still, the critics' focus is on claim "rejection," that is, the percentage of folks whose claims are outright denied. And that's a valid (if perhaps narrowly defined) metric; after all, who wants to willingly buy coverage from a carrier which routinely denies claims?

So, which is the most egregious perpetrator?

The answer may surprise you:

[ed: from page 5 of the linked report]

Yes, you read that correctly: the insurer which routinely denies the most claims is none other than the largest national health scheme we currently have: Medicare (which denies almost two and a half times as many claims as best-ranked Coventry). This is all the more bewildering, since so many folks point to Medicare as a viable, even preferable model of financing health care delivery. This should come as no surprise, however, given the drastic cuts already in place (with more on the way), which will no doubt increase the terrible score.